Rinse, Return, Repeat. Be the “Dropbox” Tortoise.

Friday FINISH – March 6, 2020

We’ve all heard the story of the tortoise and the hare. Essentially the tortoise wins because he has the long-term, marathon mentality, while the hare is on a stop-go, unfocused, take-it-for granted run. Marketing legend Dan Kennedy says that people start quitting your business or lose interest the minute they start. Studies in psychology of buying have found that as buyers, our interest is highest right when we purchase something. Then it immediately begins to drop. Sometimes that act of going to buy or knowing what you are going to buy generates more “feel-goodness” than does the actual product or service that you receive.

For example, if you’re buying a new car, day one is the most exciting, and then it fades every day from there, until you either 1) begin to take it for granted, 2) get tired of it, or 3) feel you need to buy a new one. It’s how I’ve always felt about Christmas – meaning that Christmas Eve is the MOST exciting day of the season for me, because of all the excitement and anticipation (and knowing the holiday rush will soon be over). 

So you have to keep things interesting, new and exciting, constantly building the relationship to bring your patients back for their next visit. The day of their checkup or new implant is THE most exciting day for your patient. It’s also the best time to help them accept more treatment and get them scheduled for their next visit, because the feel-good feelings are at their highest on that day. 

How do you celebrate with them? What unexpected extras do you offer them?

This is why I believe most hygiene programs in our practices are underutilized. The perceived need of doctor treatment is higher: pain, broken teeth, bad breath, bleeding mouth, all of them feel more important to the average person, and therefore people will pay more and come in sooner to have these services done. 

Where are the highest opportunity recurring collections (revenue) in your practice?

When it comes to prevention (a word that does not have any sizzle or excitement) people put it off, even though in fact everyone DOES NEED a checkup and cleaning periodically based on the needs of our mouths. Hygiene is also a huge source of recurring revenue, and with a trained hygienist and recare program, it is the closest thing to passive income you can gain in your practice if you are a solo doctor. 

Here’s how Dropbox has done well with their recurring revenue program. “Dropbox makes file-sharing software that enables collaboration among work teams. Users pay a monthly fee for larger storage space. Thus, converting free users to paid accounts is a key growth driver. Of more than 600 million users, only 14.3 million were paying customers at the end of 2019. That’s up nearly 12% from 2018….One of the company’s main metrics is total annual recurring revenue, which is the key indicator of the trajectory of its business performance….It represents the amount of revenue Dropbox expects to recur, helps measure the progress of initiatives, and serves as an indicator of future growth. In the fourth quarter, total annual recurring revenue was $1.82 billion, up 3% from Q3 and about 20% from the year-ago period.” (-Juan Carlos Arancibia, March 2020 – investors.com)

Dropbox is a great example of how to build a recurring collections stream in your practice. Offer something valuable for people to join (for them a free basic plan) and then focus on creating a lifetime customer (or patient) who pays you monthly/annually and continually gets great value in the product or service. 

Other ways to build recurring revenue into your practice include hiring associates, well trained assistants, and offering payment plans. Just ensure you have daily reports to track all of these metrics and hold the proper team members accountable to reporting back on them. 

A great exercise this week is to break down your collections by the following:

  • Hygiene collections by provider
  • Doctor collections by provider
  • 0-30 Accounts receivable, 31-60 accounts receivable, 61-90 accounts receivable, 90+ accounts receivable (90+ is what we call “bad AR” in the extreme danger zone, unless it’s part of a current payment plan)
  • Over the counter collections (non insurance)
  • Insurance collections

Average these out with 6-12 months of data, and you’ll soon see where your revenue (collections) really come from. This will help you make better decisions on things such as adding more providers, offering more or less payment plans, accepting or dropping insurance plans, etc.  In my office I was pleasantly surprised years ago to see that nearly 2/3 of our payments come from patients, whether cash pay or copayment. For my practice philosophy, this means I’m not overly dependent on insurance which wouldn’t match our service model. Even though we are very insurance friendly in my practice, we don’t belive in making decisions solely based on insurance alone. But my office and yours are different, and so will your recipe be for success. You just need to make sure you have the right ingredients to flourish. 

Have a great week!

Ocean Stingrays In Your Practice?

Friday FINISH – February 28, 2020

The past week my family enjoyed a fantastic vacation in Puerto Vallarta, Mexico. It was my surprise Christmas gift to my wife and kids this past Christmas. If you haven’t been, to Puerto Vallarta I highly recommend it, we went the all-inclusive route and it had everything we needed for a great time. Plus it’s an under 4 hour direct flight for us from Salt Lake City.

We did leave the resorts a few times on some Uber rides for a visit into downtown with a stop at Walmart (an new experience for us – did you know they sell motorcycles and stoves at Walmarts in Mexico?), and the following day a water taxi and waterfall hike in Quixmito (highly recommend) where we also found some awesome street tacos – just remember to bring Pesos because the village near Quixmito is very small and the one ATM machine they had was stolen recently. Off-site excursions are a lot of fun if you like to explore – but certainly not needed to enjoy the experience. My kids had all of the beach time, boogie boarding, pool time, catamaran ride, arcade and football games, shuffleboard, virgin drinks at the juice bar, and nighttime shows they could handle. Plus the reserved restaurants had some fantastic fish tacos and Chile Relleno. 

I don’t know if the trip could have gone much better. There were some pretty funny moments that you get with a trip that are unexpected but memorable. For me, it was when I shut our res port beach rental booth down for a day with the “Purple Flag” from receiving my first (and hopefully only) Stingray sting. 

The beach rental company outside of our hotel had 4 flag colors posted each day. Green – safe water, yellow – use caution with larger waves, red – not safe for being in the water, and purple – dangerous marine wildlife/not safe in the water. We mostly had yellow conditions during our stay, which worked just fine, and only a few hours of red flag warnings one day. But on our last day, three of the five of us were boogie boarding, when suddenly I felt two quick, sharp “bites” on my right ankle, one just over the bone and one near my Achilles’ tendon. It was so quick and intense, like a nail was pushed through my foot. I scooted across the next wave so fast I was back to shore in seconds – definitely winning my wife on that ride.

When I sat down to observe what had just happened, I thought maybe something bit me because I was struck in 2 areas. It appears that the stinger first tried to hit me in the ankle bone, but when it couldn’t get through it punctured me on the softer part of my foot instead. I had a 3-inch welt and minor bleeding, and my foot began to feel numb, as it does when you sit on your leg funny and it “falls asleep.”

After some reading up on it later that day, I discovered that Stingrays are not aggressive toward humans, and only sting you to defend themselves if you step on one. Typically they swim in families and park in the sand during afternoon hours. (Hence the purple flag, when word got around in the resort that I was stung, they put that warning flag up because there are likely many more Stingrays out. I was the one people kept saying when we were in conversation “so, you’re the guy we heard about that was stung.”) The “Stingray Shuffle” is the trick that surfers do as they scoot their feet along the sand, to create movement. This warns Stingrays someone is coming and they swim away to avoid danger – now I’ll be dragging my feet more often!

What was I really afraid of?

I wasn’t afraid of the pain or the bruise, but being a rookie, I wanted to ensure I wouldn’t have an allergic reaction or infection. So I asked a resort employee and they said “Stingray” and I was quickly escorted to the on-site clinic. The doctor was very friendly with a warm Mexican smile and laugh. He took me right into his one room chair, where before I knew it I was being prepped for injections and given a bunch of pills I couldn’t recognize. Through his broken English I understood I would receive some localized numbing, followed by a cortisone shot so that the tingling in my foot didn’t radiate higher. Then he applied some steroid and antibiotic cream to the wound and a bandage. The unmarked pills he gave me were painkillers and antihistamines (Claritin) – I skipped taking the painkillers because I prefer Tylenol + ibuprofen over the counter, but took the Claritin. Then I was over to the ATM (walking great!) grabbing some cash to pay for the service. 

Within a couple hours I the discomfort was 90% gone, and I was happy to know that all along the way I could resume our beach activities. I was very grateful for the experience, because it could have been much worse! NPR reported in 2014 that on Seal Beach in California, nearly 16,000 Stingrays dwell in the water, but only about 400 stings are reported each year. Most people heal just fine afterward. Of course there are the fluke happenings, like when our favorite Crocodile Hunter, Steve Irwin was stung in the chest, and it penetrated his heart and took his life back in 2006. That was a sad day for our family, we used to love watching his passion for animals and wildlife. 

What kinds of “stings” terrify you in your practice? Do you stay up at night worrying about payroll, employees leaving, or where you’re new patient sources will come from? It would be easy for me to quit and never go back into the ocean again. Statistically it will probably never happen to me again. But most importantly, I can’t let one sting keep me from enjoying a vacation with my family. Even if I was stung again, I’d be better prepared and know what to do next. 

If you have anything that is “stinging” your practice or professional career right now, please reach out to me and let me know how I can help!

Have a wonderful weekend and strong FINISH today!

One Dimensional Marketing

Friday Finish – February 21, 2020

“One is the loneliest number.” This song by Harry Nilsson topped the Billboard charts in 1969, and it’s lyrics still ring true today.

According to Investor’s Business Daily, “On Monday, Apple warned that it likely will not meet its guidance for the current quarter because of business interruptions related to the outbreak of the current coronavirus strain known as Covid-19.

‘Work is starting to resume around the country, but we are experiencing a slower return to normal conditions than we had anticipated,’ the company said in a note to investors. Apple said its worldwide iPhone supply has been constrained by the factory closures in China due to Covid-19.”

This brings up an important point regarding your marketing, and your source(s) of new patients. 


I hope, and could probably guess that Apple has a backup plan in case their sources of electronics in China ever dried up, but can you imagine if your supplier of parts and pieces of your iPhone and other Apple products suddenly cut you off?

What are your best sources of new patients in your practice? How many do you have? Do you review this weekly with your office manager or marketing team?

If for example insurance is your main source for new patients, and suddenly a large local employer drops that plan, how will that impact your practice? Google changes its algorithm weekly, if not daily. If you’re new patients come primarily from Google search, like many of ours do, and out of the blue Google drops your listing or says your ads are no longer approved, how will this affect your practice?

Imagine you are filling a large bathtub when growthing your practice, not only do you need to plug the leaks to prevent it draining (and there are always a few leaks that you can never fully stop, but you should contain and slow them to a very small drip), but you also need to constantly find new ways to keep the faucet flowing. 

If your practice only has one “faucet” or source for new patients and that faucet breaks, how long until you have it fixed? What ways will you be impacted in the meantime?

A year or so ago, someone who was managing part of our online marketing, let Google change our listing type into a hospital instead of a dental office, and guess what happened? You got it – boom – no more new patients from Google for weeks until we figured it out. We weren’t coming up on any local searches for the word “dentist” at all. Luckily, since we watch the numbers on a daily and weekly basis, we noticed the problem internally and made quick adjustments. We soon had to fire our online listing manager for being so neglectful. His job was to monitor this regularly, and he let weeks go by without even noticing – we had to find it on our own.

Fortunately, this was not our only new patient source so we recovered just fine. But if we had no other marketing sources except this one, we could have been in deep trouble or even financial ruin, especially if we were the size of Apple. (A big advantage of running a small business is it’s usually easier to turn the ship around when you approach dangerous waters.) We had more than one “faucet” filling our tub so we weathered the storm just fine and learned from the experience. 

The message this week: always be looking for new ways to improve your current lead sources, and find the new one’s that are performing with at least a 3:1 front end ROI. Make your marketing plan multidimensional, always with a contingency plan

Have a fantastic weekend!

If you would like to receive more information like this or provide your feedback, simply send me an email at twilliams@pinecrestdds.com and put “Friday Finish” in the subject line. 

What do you LOVE?

Friday FINISH – February 14, 2020

Your are the reason we love Practice Growth!

Today is Valentine’s Day.

So, what do you really LOVE? What gets you out of bed in the morning? Who around you do you love? Do you love your job? Your practice? What hobbies do you love? What recreation do you love to participate in? These are all important things to recognize, not just for what and who they are, but for your mental and physical health.

I could work more than I do if I had to (not that it would be healthy to do so), especially on the practice because I love being in the “lab” of testing new ideas to grow my awesome team, make our patient experience better, and new ways to hit our goals with marketing. It gets me excited to jump out of bed each morning. 

When we reflect on the story of St. Valentine, we think of love. But he represented not just love in general, but courtly love – which ties into chivalry and respect. Interestingly, St. Valentine was also the patron saint of epilepsy according to the Epilepsy Foundation. This was thought to be derived from medieval times when people with illnesses would not just medical advice, but would also seek spiritual guidance for help.

I hope you have a fantastic Valentine’s Day with those you love. YODA reason we love helping other practices reach their potential

If I can help in any way, please reach out. Have a fantastic week!

If you want to receive more information like this, simply send me an email at twilliams@pinecrestdds.com and put “Friday Finish” in the subject line. 

Chinese Foot Massage


Chinese Foot Massage– February 7, 2020

Recently my wife invited me on a date for a “Chinese Foot Massage” at a little shop in a strip mall a few miles away from my home.

Sounds a little strange, right?

Well, it gets even better from here. This “Foot Massage” is actually a full body massage. You walk in, they ask you one question, if you want feet only or full body. From there, no more questions or talking, they just take over while you relax.

I used to think a professional massage was the weirdest thing until I tried it. I’m not sure how my wife ever found this place, but I think it was recommended to her. It’s not your typical massage therapist style either. They use Chinese Reflexology, which is a little different, but very effective. 

There are no frills here. They use old towels to keep you warm, and your feet go in a plastic bucket with a plastic liner and warm water. Old massage type chairs that look more like a recliner but they do have a hole in the headrest for when you lay face down.

Some traditional Chinese music plays from a little speaker in the room, no centralized sound system here. It’s very clean and they are professional. As many “mom n’ pop” shops go, they charge you a credit card fee, but it’s cheap.

Really cheap.

It was originally $45/hour, but they ran a special for $35/hour awhile back when my wife went. Now their sign on the door has a slash through $45/hour and it says $35/hour.

While they are fairly busy, I instantly wondered, “are they actually making any money here?” It can’t be free to hire licensed professionals. If my hygiene department ran that lean we woulnd’t make any money, but maybe these guys have figured out a way to make it work with bare bones overhead. But my gut says they haven’t. (Which is also why I gave them a big tip because I feel for them and they did an excellent job.)

It appears to be a family run business, with the owners and their children doing most of the work. It looks like they work long days and late hours, which is respectable but probably not sustainable or a real “business” that can be sold. It’s more of a self-employed job.

What fees are you slashing? What areas of service are you cutting back in? Or are you adding up?

I’m a bigger fan of valuing up rather than discounting down. There will always be someone else lowering their fees or “rolling back” prices. You can play the low game or the high game, but usually if you are in the middle you’ll get burned. 

Find ways to add value to your patient experience. Even a free bite adjustment on a crown or implant is added value. You’re going to do it for free anyway if your patient needs it, so you may as well use it as a case acceptance tool or as part of your “selling proposition.” Here are 4 examples:

  1. If your crown fee is $1000 and you have a 30% profit margin/70% overhead, and you “slash” your crown fee to try and gain more business, remember that you now have 82% overhead and a 18% profit margin.
  2. Instead, find ways to value up, such as offering your patients more convenient appointment times (our evening and Saturday spots have filled up quickly since we started offering them 7 or so years ago). 
  3. Offer both options, with the higher priced one being an upgrade of better material, longer warranty, etc.
  4. Always know your math, you can solve just about any problem in the world with the right math (that is why I was an Economics major in college and why I love Algebra – nerd right!).

If I can help in any way, please reach out. Have a fantastic week!

If you want to receive more information like this, simply send me an email at twilliams@pinecrestdds.com and put “Friday Finish” in the subject line.